What are the thoughts on sterile tubing changes for central lines? I know many facilities seem to be doing this, but is there supporting evidence?
Aseptic no touch technique is required. There is no way to do "sterile" technique because the exterior of I. V admin sets are not sterile. The sterile components are ends under the caps and fluid pathway. See the package for these details. So do not allow those ends to contact anything and you are good. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
Are you talking about using new IV tubing on a new CVAD of any kind that has just been placed?
I interpreted the original question to be a routine change of administration sets at the designated number of hours, most commonly 96 hr. Your question is different and yes a newly inserted VAD of any type requires a new administration set. There are extension sets that are labeled as completely sterile and can be added to your sterile field but this does not include the complete administration set, Always read the product label for this information. Lynn
to clarify, when adminstration sets are changed on central lines, many facilities are making this a "sterile" process (as sterile as it can be) using sterile gloves, mask, sterile field, and in some cases, even sterile gown and cap. Although it is not completely sterile because the IV bags are not sterile and even administration sets are not externally sterile in most cases, the process starts sterile and ends aseptic, with the purpose of reducing risk of contamination throughout the process as all connections are being made. I can not find any guideline that recommends this, or even a written procedure to follow. On you tube there are examples of how different facilities have done this as part of their CLABSI prevention strategy. I was just looking for published evidence, but so far only found a poster presentation. Yet when I talk to other clinicians, many are doing it, having come up with their own process.
It is not recommended in the 2014 SHEA Compendium Chapter on CLABSI as we had no evidence to recommend this. It is also not included in the forthcoming 2016 INS Standards of Practice - again no evidence of this practice. There is a new Implementation Guide on CLABSI prevention from APIC which I also worked on and it is not in that document either. Posters and podium presentations are not used as references for these documents. No-touch aseptic technique is what should be done, in my opinion. But sterile or aseptic technique can not be done because the entire IV set is non sterile on the exterior side. Some extension sets are packaged sterily so you could do sterile technique with those as long as the other set components do not contaminate the field, but again, no evidence that I have seen. Lynn